所謂孤立性心筋炎の病理

抄録

Five autopsy cases of so-called isolated myocarditis were reported. Case 1 was a man aged 34, who had had a sudden onset of pain in the chest, dizziness, nausea and vomiting suggesting the signs of cardiac failure. He had fell into shock and died 3 days after the onset Histopathological examinations disclosed diffuse interstitial inflammatory cell infiltration throughout the myocardium, consisting of mononuclear cells, lymphocytes, plasma cells, eosinophils, leucocytes and cardiomyocytes. There was a pronounced associated parenchymatous changes with fatty change, loss of striation and granular fragmentation of the myofibrils. Case 2 was a man aged 68, who died of apoplectic fit. Besides massive hemorrhage into the brain, histopathological studies revealed granulomatous myocarditis characterized by the presence of focal non-caseating lesions consisting of epithelioid cells and multinucleated giant cells, which occasionally resembled tubercles. No granulomatous lesions were demonstrated in the other organs. The third case was a man aged 48 who had a chronic downhill clinical couse of ten months duration with difficulties in respiration, palpirarion, pulse irregularities and the physical signs of hypertrophy of the heart. At autopsy the heart was found enlarged, weighing 440g., and the visceral organs congested. Diffuse interstitial fibrosis was noted in the heart with varying degrees of degeneration of muscle fibers and a few rounded cell infiltration. Case 4 was a man aged 64, who died of the cancer of the right lung with widespread metastasis. An isolated involvement of the heart by nonspecific inflammatory changes was an unexpected microscopical finding of this case. The fifth case, a man aged 42, was of a typical case of sudden death due to myocarditis. Rounded cell infiltration, focal in character, was found isolated in the myocardium.
All 5 cases described were characterized by selective involvement of the heart by non-specific inflammatory lesions. Three cases were of more or less diffuse infiltrative variety, one was of granulomatous and the other was of chronic fibroblastic variety. No conclusive histological evidence was demonstrated suggestive of the possible causative mechanism. There was, however, a case in which subacute inflammatory changes in the thyroid and alveolitis of slight degree were found. It appeared that these lesions may suggest the possible relation of Fiedler's disease to myocarditis following infectious diseases.